Oh my aching feet!

By admin
May 13, 2013

Love your stilettos or flip flops? Your feet could be paying for your fashion.

The average person takes around 10,000 strides per day, so an individual’s choice in footwear has a tremendous effect on their body, especially their feet. And yet, most of us select our footwear based on season, fashion trends and coordination with our wardrobes, instead of comfort and proper fit. Americans spend more each year on shoes, and despite shelling out some serious cash, the majority of us still complain of aching feet.

If you are one of those people who thinks the cost of shoes is getting out of control, but still pay the high prices for the fashion you love only to wince with pain whenever you wear them, consider the hidden costs that could come back to bite you on the toe and in the pocketbook.

Women comprise about 90 percent of the 795,000 annual surgeries for bunions, hammertoes, neuromas (trapped nerves) and bunionettes – the four most common problems linked to poorly designed and poorly fitting shoes. Approximately two-thirds of these conditions requiring surgery can be attributed to the patients’ footwear selections. The total estimated cost for this avoidable surgery is $2 billion annually, and that’s just for the women.

With an average time lost from work of four weeks per person, it amounts to about a $1.5 billion loss to the economy. That’s a total of 3.5 billion healthcare and workforce dollars lost each year because of “less than sensible” shoes.

Two guilty culprits in the daily crimes against feet are from opposite ends of the shoe spectrum…stiletto heels and flip flops. One is designed for high fashion and the other, ironically, for casual comfort, but both take their tolls on unsuspecting wearers who may eventually find their way to physicians with complaints of chronic pain.

Penny J. Lawin, M.D., Orthopaedic Surgeon and foot and ankle specialist with Mississippi Sports Medicine and Orthopaedic Center, spoke to Well-Being about the most common foot damage and injuries that she sees in her practice, which are attributable to shoes.

“Everyday patients walk into my office with complaints of aching feet or injuries from mishaps caused by their footwear,” notes Dr. Lawin. “Many people don’t realize the effects of ill-fitting shoes, or shoes designed for their visual impact instead of comfort or protection, can be long-term and sometimes irreversible without surgery.”


According to Dr. Lawin, people wearing stiletto heels on a regular basis are more prone to injury than those wearing more sensible shoes. However, since stilettos are worn primarily by women, they don’t account for the majority of the damage and injuries to feet caused by footwear each year. Still, the damage they inflict is significant.

“The most obvious injuries caused by stiletto heels are ankle and foot fractures and sprains. Stilettos are inherently unstable so it doesn’t take much to lose balance.” Dr. Lawin adds, “Additionally, high heels may contribute to shortened calf muscles leading to an unnatural gait.”

If the aforementioned conditions are not enough to dissuade the most ardent stiletto aficionados, there’s more. The exaggerated angle and shallow narrow toe box of high heels places increased pressure on the ball of the foot and the metatarsal heads (bones at the base of the toes). In fact, a 3-inch heel creates seven times more stress on the forefoot than a 1-inch heel. This can result in the development of a multitude of ailments including bunions, hammertoes, Achilles tendonitis, bunionettes, fat pad atrophy (loss of the shock absorbing pad at the ball of the foot), metatarsalgia, MTP synovitis and instability, arthritis, stress fractures, corns and calluses, and even ingrown toenails. Many of these conditions can be relieved only with surgery.

Flip Flops

The problem with most flip flops starts with their wimpy rubber bottoms providing very little shock absorption, and leaving one’s foot to absorb the shock the shoe was meant to accept. This repetitive trauma to the foot can lead to stress injury. According to Dr. Lawin, “the bottom of the foot is the only place one wants to have an abundance of fat as padding. Unfortunately, it is also one of the few places fat goes away with age.”

The progressively worsening effect of irritation caused by wearing flip flops is described: “Because of the open back design, the flip flop wearer has to grip the shoe with his or her toes to keep it on,” explains Dr. Lawin. “This increases the use of joints at the ball of the foot, causing irritation. If the irritation (which usually starts as itching) is ignored, the joint begins to swell. As the joint swells, the itching progresses to a feeling like walking on marbles. With joint swelling, the ligaments normally holding the toes in alignment start to stretch, allowing the toe to become unstable. The deformity starts out with toes that separate (see picture), but ultimately can advance to the second toe crossing over the big toe.”

Constant gripping with toes also increases the strain across the main arch ligament and underlying muscles. Over time the ligament and muscles become tight, which can lead to a very painful arch and heel problem called plantar fasciitis.

The lack of support in most flip flops allows the arch to drop in at-risk individuals – those with flat feet, overly flexible feet, and those overweight or obese. These unsupportive shoes allow additional pressure on feet that are already overly strained. This contributes to pain not only in the foot, ankle and leg, but also can affect the knees, hips and back.

Flip flop wearers are also at risk of accidents. Since each step starts with a heel strike, it is easy to step out of a shoe while walking, causing injury.

The take-away for stilettos and flip flops

As with most things that are potentially dangerous or detrimental to our health and wellbeing, moderation is the key. Wearing stiletto heels or flip flops only occasionally presents less of a risk for injuries or long-term damage. Consider wearing fashionably high heels only for special occasions. The American Orthopedic Foot and Ankle Society (AOFAS) discourages wearing fashion shoes with a heel height greater than 2-1/4 inches and recommends high heel wearers limit themselves to two or three hours in such shoes per day.

Likewise, Dr. Lawin recommends that flip flop wear be limited. “I don’t see a problem with wearing flip flops to the pool, beach, or locker room” she adds, “but not as an everyday shoe of choice, and certainly not for playing football or Frisbee, working in the garden, mowing the lawn or running errands. If flip flops are a must, choose one with a deep heel cup to keep the foot seated, an arch support, and a sole that is not too thin, but not too weighty. Avoid places with unstable footing – uneven ground, cobblestone, gravel, etc. Bottom line…if your foot hurts, choose another shoe.”

Improperly Fitting Shoes

A 1993 AOFAS survey of 386 women found that 88 percent wore shoes too small for their feet, 80 percent reported pain and discomfort and 72 percent had one or more foot deformities.

Forcing the foot into a shoe too small and subjecting it to daily pounding and pressure also causes deformities over time. Bunions, hammertoes, claw toes, bunionettes and other painful conditions are often the result of poorly fitting shoes. Not great looks no matter what your shoe style is. Before buying your next pair of shoes make sure you have your foot measured properly and select shoes that are the correct length, width, and height, with support at the arch and enough room in the toe box for your toes to fit comfortably.

Respect your feet…remember they are all you have to stand on.

Penny J. Lawin, M.D., Orthopaedic Surgeon with Mississippi Sports Medicine and Orthopaedic Center in Jackson, received a Bachelor of Science Degree in Bioengineering from the University of Illinois prior to entering Rush Medical College in Chicago, where she earned the Doctor of Medicine degree. Her professional training in Orthopaedic surgery includes a five-year Orthopaedic surgery residency at Rush University Medical Center and a one-year fellowship in foot and ankle surgery at Duke University Medical Center. Dr. Lawin is Board Certified in the specialties of Orthopaedic Sports Medicine, and Orthopaedic surgery with a special interest in foot and ankle surgery.

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